TY - JOUR
T1 - Clinicopathological findings in abusive head trauma
T2 - Analysis of 110 infant autopsy eyes
AU - Breazzano, Mark P.
AU - Unkrich, Kelly Hodson
AU - Barker-Griffith, Ann E.
N1 - Funding Information:
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors indicate no financial conflict of interest involved in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript. The Research Foundation of the State University of New York, Upstate Medical University, did receive grant support for principal investigator Ann Barker-Griffith from Allergan , Inc in the past 2 years for a different research project (Award # 1093015-56657-1). This study was funded by unrestricted grants from Research to Prevent Blindness Inc , New York, New York, USA (Unrestricted Grant Project # 1023403-66915-13); and Lions District 20-Y1 , Syracuse, New York, USA (Foundation for Upstate Medical University, Lions Vision 2000 Fund Number 242). Contributions of authors: design and conduct of the study (M.P.B., A.B.-G.); collection, management, analysis, and interpretation of the data (M.P.B., K.H.U., A.B.-G.); preparation (M.P.B., K.H.U., A.B.-G.), review (A.B.-G.), and approval (M.P.B., K.H.U., A.B.-G.) of the manuscript.
Publisher Copyright:
© 2014 The Authors.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - PURPOSE: To investigate the histopathology in a large series of autopsy eyes from children with abusive head trauma.DESIGN: Retrospective case-control series.METHODS: One hundred and ten eyes from 55 autopsies examined at an academic tertiary referral center over 21 years were tabulated for histopathology: subdural hemorrhage in the optic nerve sheath, intrascleral hemorrhage, any retinal hemorrhage, ora-extended hemorrhage, cherry hemorrhage, perimacular ridge, and internal limiting membrane tear. Select tissues with cherry hemorrhage were further examined by transmission electron microscopy.RESULTS: Sixty eyes were identified as "abusive head trauma" (cases), 46 as "alternative cause" (controls), and 4 as "abusive head trauma survivor". Cases were legally verified or confirmed by confession in all except 1 case. All ocular histopathologic observations from cases were similar or more frequent in infants younger than 16 months of age. When present, a cherry hemorrhage and perimacular ridge were most often found together, and only with a torn internal limiting membrane. Both abusive head trauma survivor cases demonstrated severe optic nerve atrophy and macular ganglion cell loss.CONCLUSIONS: Younger infants may be even more susceptible to damage from vitreomacular traction by rotational and/or acceleration-deceleration forces. Identifying cherry hemorrhages may aid abusive head trauma diagnosis. Survivor abusive head trauma pathology demonstrates unique, irreversible macular and optic nerve damage.
AB - PURPOSE: To investigate the histopathology in a large series of autopsy eyes from children with abusive head trauma.DESIGN: Retrospective case-control series.METHODS: One hundred and ten eyes from 55 autopsies examined at an academic tertiary referral center over 21 years were tabulated for histopathology: subdural hemorrhage in the optic nerve sheath, intrascleral hemorrhage, any retinal hemorrhage, ora-extended hemorrhage, cherry hemorrhage, perimacular ridge, and internal limiting membrane tear. Select tissues with cherry hemorrhage were further examined by transmission electron microscopy.RESULTS: Sixty eyes were identified as "abusive head trauma" (cases), 46 as "alternative cause" (controls), and 4 as "abusive head trauma survivor". Cases were legally verified or confirmed by confession in all except 1 case. All ocular histopathologic observations from cases were similar or more frequent in infants younger than 16 months of age. When present, a cherry hemorrhage and perimacular ridge were most often found together, and only with a torn internal limiting membrane. Both abusive head trauma survivor cases demonstrated severe optic nerve atrophy and macular ganglion cell loss.CONCLUSIONS: Younger infants may be even more susceptible to damage from vitreomacular traction by rotational and/or acceleration-deceleration forces. Identifying cherry hemorrhages may aid abusive head trauma diagnosis. Survivor abusive head trauma pathology demonstrates unique, irreversible macular and optic nerve damage.
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U2 - 10.1016/j.ajo.2014.08.011
DO - 10.1016/j.ajo.2014.08.011
M3 - Article
C2 - 25127695
AN - SCOPUS:84912098468
SN - 0002-9394
VL - 158
SP - 1146-1154.e2
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 6
ER -